CARE HOMES FOR OLDER PEOPLE
Milton House Nursing Home Marton Road Gargrave Skipton North Yorkshire BD23 3NN Lead Inspector
Mary Slattery Unannounced Inspection 10:15 6 March 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Milton House Nursing Home Address Marton Road Gargrave Skipton North Yorkshire BD23 3NN 01756 748141 01756 748141 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Winston Shutt Mrs Carol Shutt Mrs Hilary Ormrod Mrs Patricia Sykes Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age Range 65 years upwards Date of last inspection 25th July 2005 Brief Description of the Service: Milton House is registered to provide personal and nursing care for twenty-two service users aged 65 years and above. The main part Milton House is over 200 years old and this provides the lounges and a small number of bedrooms. There is additional purpose built accommodation providing further bedrooms, dining room and a new conservatory lounge. The home is located within a short drive of the village centre and there is ample parking space for visitors and staff. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 6th March 2006. The inspection took four plus 2 hours preparation time. A tour of the premises was carried out, which included service users private accommodation. Time was spent observing the activity in the home, talking and listening to the service users to establish if they were satisfied with the care and support they received. Time was also spent talking to a number of the staff on duty to discuss their roles and responsibilities and their experiences of being part of a team responsible for providing care to the people living in the home. The registered providers and one of the registered managers were available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
Milton House provides nursing care, personal care and accommodation for older people and makes available information about the home; the facilities, the staff and the type of care service users should expect to receive. There was information for the service users and visitors about how to make a complaint on any aspect of the service. The atmosphere was relaxed and the service users contributed to the inspection by expressing their views of the care they are given and the kindness of the staff. Staff were seen to deal promptly with issues raised by service users and there was good interaction between the service users and the staff All of the service users appeared well cared for and there was a range of communal space, comfortable seating and equipment for each person. They have established good communication systems and keep all staff informed about the needs of the service users and any changes in their conditions. There is a good system in place for the induction and training of staff and opportunities for them to meet regularly to discuss all aspects of the service. The home was warm, clean and bright, well maintained and decorated to a high standard. The service users said they enjoyed the food and they had plenty of choice about what they eat, when they get up and go to bed. They keep good and
Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 6 regular contact with their family and friends and have opportunities to enjoy social activities. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. People are provided with considered information about what the home offers to provide. EVIDENCE: The statement of purpose and the service user guide contain a lot of information about the service, the accommodation and the facilities that are provided. There is information about the staff that are employed and the arrangements for making a complaint about the service. There is a contract and a terms and conditions document the details of which are discussed and agreed with service users and a copy is kept on individual service users files. All prospective service users and members of the family are invited to visit the home to assess the service and facilities before they make a decision to move in and visitors are welcome in the home. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. There are good systems in place to make sure that the service users health care needs are met. Improvements need to be made to the medication records. EVIDENCE: A number of the service users care plans were looked at and there was information to show that their needs had been assessed and individual care plans put in place to assist the staff in meeting individual needs. Nutritional assessments had been carried out and evidence that people’s weight and nutritional needs were monitored and reviewed on a regular basis. There was good provision of pressure relieving equipment and a wide range of equipment to assist service users with their mobility. Contact is maintained with external health care professionals including the service users, general practitioners, continence advisor and tissue viability nurse. The nursing staff are responsible for the care and care planning for service users needing nursing care and the care staff for those service users who need personal care. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 10 The daily records gave information about the type and level of care, any changes in their health. All of the service users that I met told me that they received good care from the staff and that all of their care was delivered in privacy and the staff were kind. The medication system and facilities were inspected and gaps were found in the records. There was evidence to show that 2 Paracetamol tablets were borrowed from one service users supply and administered to another service user who was also prescribed Paracetamol. Where service users had not wanted to take medication such as Lactulose on a regular basis as prescribed, no action was taken to discuss this with the general practitioner to determine if it would be reasonable to alter the prescription. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. The service users are able to make decisions about their lives, keep contact with family and friends and decide what they are going to do each day. EVIDENCE: The service users have good and regular contact with their family and friends and the staff encourage and support them to remain as independent as possible and to make decisions about how they wish to live their lives. A number of the service users go out and about locally and the home offers a wide range of social activity. The service users have free movement around the home and opportunities to spend time in conversation with each other and the staff. I was informed by service users that they rise and retire at a time suitable to them and that the staff gave them the support and assistance they needed including the use of hoist and wheelchairs. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Staff are available to listen to any concerns the service users may have and information about how to make a formal complaint is provided. EVIDENCE: The home has a relevant complaints procedure in place and all complaints are dealt with according to the procedure. There have been no recent complaints made against the service. The required checks are carried out on all staff prior to them taking up their post. The staff would benefit from abuse awareness training and to become more familiar with the homes policies and procedures. They would benefit from obtaining a copy of the local authorities policy and procedure for the protection of vulnerable adults and to become familiar with the procedure for reporting any allegation or suspicion of abuse in line with the procedure. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23, 24 and 25. The standard of the environment is good providing the service user with a bright, clean, homely place in which to live. EVIDENCE: The accommodation provided is of a high standard and there is a range of communal sitting rooms and a dining room. A wide range of equipment is provided to assist with mobility including hoists, assisted baths and toilets. There is a passenger lift and a stair lift giving access to the upper floor and there is level access inside the home and to the garden. The service users decide how they wish to arrange their rooms to suit their tastes and to accommodate their hobbies and interests. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. The Service users receive a high standard of care from a motivated staff group. EVIDENCE: The home employs qualified nursing staff, care staff, domestic and catering staff in sufficient numbers to meet the needs of the service users. All staff have a full induction in to the home’s policies and practices and attend training in first aid, health and safety, moving and handling and food hygiene. The nursing staff have the relevant general nursing qualification and attend training courses to up date their practice. There is NVQ training in place for the care staff and 2 staff have achieved NVQ Level 2 and 2 have achieved NVQ Level 3. The home has the required numbers of staff on duty during the day and overnight. Three staff files were looked at and the required records were in place and evidence that the required checks had been carried out. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The service users benefit from a well managed home where their needs and wishes are put first. EVIDENCE: The registered managers are qualified first level nurses and undertake the dayto-day management of the home jointly. They would benefit from undertaking the Registered Manager’s Award or equivalent management training. The registered providers and the manager work closely together to ensure that the service users receive good quality care and that their views are listened to. Meetings take place on a regular basis enabling the staff and the service users to voice their opinions about all aspects of the service provided and to contribute to any future changes.
Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 16 There is no system in place for the staff to have formal supervision - they do have an annual appraisal. The required records, policies and procedures were in place and found to be in good order and up to date and available to the staff. The home has a health and safety policy and procedure and staff are subject to health and safety training. Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X 3 3 3 3 3 3 X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 2 X 3 Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person is required to keep accurate medication records and adequate supplies of prescribed medication available for service users. Timescale for action 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations It is recommended that all staff attend abuse awareness training and that they become familiar with the local authorities policy for reporting any allegation or suspicion of abuse. It is recommended that the registered managers undertake management training. It is recommended that there is a programme of formal supervision in place for all staff. 2 3 OP31 OP36 Milton House Nursing Home DS0000027942.V276322.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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